Richard Sullivan, Co-Director of the Centre for Conflict and Health Research, and Professor of Cancer and Global Health at King’s College London, shared a post on LinkedIn:
“After a hiatus of more than a decade, England has finally published a new national cancer control plan. It is, frankly, sophistical in argument but worse, treacherous to clinical reality. The NCP claims that England will become a global leader in cancer survival by 2035. This ambition is strikingly unrealistic considering where we are today and the mounting pressures on service delivery. Most notably, the document provides little clarity on the substantial new investment that will be needed. Instead, it relies heavily on re-announcing funding that has already been committed, often under broad, system-wide programmes.
Examples include the £2.3 billion allocated for diagnostic transformation, encompassing £604 million in capital expenditure for digital diagnostics and £96 million for histopathology automation. Throughout the Plan, there is a recurring and largely unsubstantiated assumption that technology will deliver significant productivity gains. For instance, the Plan suggests these investments will yield a 16% increase in histopathology productivity, with additional gains of 6% and 4% from unspecified adjustments.
Such claims lack evidentiary support and will only further strain the system. Similarly, the £70 million allocation for radiotherapy equipment is presented as a new investment, even though it is insufficient to meet current needs. There is new money, e.g., £80m for 4 new NHS aseptic medicine production hubs, but the sums involved feel inadequate for the scale of the challenge.
The language of the Plan also merits scrutiny. Terms such as “revolution” are used repeatedly, yet they are almost exclusively technological. The document places disproportionate emphasis on expanding access to innovative cancer treatments, particularly pharmaceuticals, even though England does not face a significant access problem but rather a substantial delivery challenge.
Predictably, the Plan places heavy reliance on technology as the cornerstone of systemic improvements; artificial intelligence, genomics, the NHS App, wearables, digital technologies, and multi-cancer early detection (MCED) tests are repeated as techno-soundbites to the point of exhaustion. In contrast, medical and clinical oncology receive minimal attention, while surgery is discussed almost exclusively in the context of robotics. The clinical disciplines at the heart of patient care, including nursing, have been drowned in a sea of technology and discombobulated initiatives.
The new English NCP reads less like a coherent, clinically-centred health system strategy and more like an industrial policy document. Critically, there is scant recognition of the role of social determinants of health, nor of the importance of system-level organisation, service integration, and care pathways in improving outcomes. While important themes such as quality are there, they are not meaningfully integrated into a cohesive framework. The document is fragmented and frequently appears disconnected from the realities of frontline clinical practice.
The most serious failing, however, concerns the workforce. Despite rhetorical commitments to workforce investment, the Plan explicitly states that its objective is to move beyond “ever more headcount” in oncology, instead seeking “innovative” ways to equip the workforce—implicitly through technological substitution. This reflects an assumption that technology can compensate for shortages in oncologists, surgeons, and other cancer care professionals.
Apart from limited and evidence-based examples such as task-shifting in endoscopy, workforce transformation is framed almost entirely in technical terms. This approach reveals not only fiscal constraints but also a deeper, misguided belief that technology can substitute for human-centred care. The absence of a credible workforce strategy undermines all downstream planning. For example, addressing surgical capacity requires not only training and recruitment but also significant expansion of operating theatre infrastructure. This failure to adopt a genuinely systems-based perspective recurs throughout the Plan.
The research strategy is similarly myopic. It is dominated by MCEDs, personalised therapies, and continued emphasis on AI, genomics, and mRNA technologies. There is little evidence that the Plan has considered the full breadth of cancer research needed to deliver better, more affordable, and equitable outcomes. It largely ignores vast swathes of cancer research excellence across the UK, including public-good research in areas such as palliative care, surgery, and radiotherapy.
Research that ensures delivery in the real world – implementation science, health services research and the social science disciplines – is ignored. This omission risks marginalising large segments of the UK’s research community and prioritising commercially driven agendas over broader public health needs.
England has an outstanding and experienced clinical community, cancer services (despite the shortcomings), research excellence, and data infrastructure, including the world-leading National Cancer Audits. Developing a coherent, clinically grounded national cancer strategy—even in today’s contested, constrained fiscal environment—should have been entirely achievable. The failure is political. Choices led us to where we are now. As it stands, many facets of this NCP are unlikely to survive contact with the clinical, social and economic realities of England today. So, what to do? One can reasonably argue that at least a poor plan is better than no plan at all.
This can at least act as a galvanising totem around which the Royal Colleges and the clinical community can engage to (re)shape cancer policy across England. And for that reason alone, this is a step forward.”
More posts featuring Richard Sullivan on OncoDaily.